A systematic algorithm for large-bore arterial access closure after TAVI: the TAVI-MultiCLOSE study.

Autor:	Rosseel L; The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.; Cardiology Department, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium., Montarello NJ; The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark., Nuyens P; The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark., Tirado-Conte G; The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark., Quagliana A; The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark., Cornelis K; Cardiology Department, Algemeen Ziekenhuis Maria Middelares, Ghent, Belgium., Floré V; Cardiology Department, Algemeen Ziekenhuis Maria Middelares, Ghent, Belgium., Rosseel M; Cardiology Department, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium., Bieliauskas G; The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark., Sondergaard L; Consultant Cardiologist, Abbott, Santa Clara, CA, USA., De Backer O; The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Jazyk:	angličtina
Zdroj:	EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology [EuroIntervention] 2024 Mar 18; Vol. 20 (6), pp. e354-e362. Date of Electronic Publication: 2024 Mar 18.
DOI:	10.4244/EIJ-D-23-00725
Abstrakt:	Background: Despite transcatheter aortic valve implantation (TAVI) having become a routine procedure, access site bleeding and vascular complications are still a concern which contribute to procedure-related morbidity and mortality. Aims: The TAVI-MultiCLOSE study aimed to assess the safety and efficacy of a new vascular closure algorithm for percutaneous large-bore arterial access closure following transfemoral (TF)-TAVI. Methods: All consecutive TF-TAVI cases in which the MultiCLOSE vascular closure algorithm was used were prospectively included in a multicentre, observational study. This stepwise algorithm entails the reinsertion of a 6-8 Fr sheath (primary access) following the initial preclosure with one or two suture-based vascular closure devices (VCDs). This provides the operator with the opportunity to perform a quick and easy angiographic control and tailor the final vascular closure with either an additional suture- or plug-based VCD, or neither of these. Results: Among 630 patients who underwent TF-TAVI utilising the MultiCLOSE algorithm, complete arterial haemostasis was achieved in 616 patients (98%). VCD failure occurred in 14 patients (2%), treated with either balloon inflation (N=1), covered stent (N=12) or surgical repair (N=1). Overall, this vascular closure approach resulted in a minor and major vascular complication rate of 2.2% and 0.6%, respectively. At 30 days, only one new minor vascular complication (0.2%) was noted. In-hospital and 30-day all-cause mortality rates were 0.2% and 1.0%, respectively. Conclusions: Use of the MultiCLOSE vascular closure algorithm was demonstrated to contribute to an easy, safe, efficacious and durable vascular closure after TF-TAVI, resulting in a major vascular complication rate of less than 1%.
Databáze:	MEDLINE
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